A systematic review of policy frameworks and advocacy strategies for promoting sustainable pharmaceutical practices and responsible antibiotic use: From local to national implementation

The issue of antimicrobial resistance remains a global challenge. This paper presents policy frameworks and strategies for promoting sustainable pharmaceutical practices and responsible antibiotic use in the United States, from local to national implementation. The study looks at how current policies at the federal, state, and local levels affect antibiotic prescribing behaviors and resistance patterns. The results of key federal policies, including FDA's Guidance for Industry #213 and CDC's Core Elements of Hospital Antibiotic Stewardship Programs, have hinted at the potential to cut unnecessary antibiotic use. We highlight state-level initiatives like California’s Senate Bill 27, as an example of potential for targeted legislation on antibiotic use in agriculture. In addition to reviewing these initiatives, the review assesses advocacy strategies, including CDC's Be Antibiotics Aware campaign and provider education programs, that have helped to increase awareness and improve prescribing practices. Effective public-private partnerships, like the Antimicrobial Resistance Challenge, serve as effective models for engaging stakeholders. Yet, scaling up successful local initiatives to national impact continues to be difficult due to variations in state policies, funding constraints, and a requirement for standardized data collection. This study also compares U.S. approaches to international strategies and identifies areas where improvement is required. These recommendations include strengthening data collection systems, expanding stewardship efforts in primary and long-term care, developing new funding models, and improving interdisciplinary collaboration. Overall, this review highlights the need for concerted activities of multiple sectors including policy development and advocacy to develop effective strategies against antibiotic resistance.